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In recent years, malaria has emerged as a cause célèbre for voguish philanthropists. Bill Gates, Bono, and Laura Bush are only a few of the personalities who have lent their names—and opened their pocketbooks—in hopes of curing the disease. Still, in a time when every emergent disease inspires waves of panic, why aren’t we doing more to eradicate one of our oldest foes? And how does a parasitic disease that we’ve known how to prevent for more than a century still infect 500 million people every year, killing nearly 1 million of them?
In The Fever, the journalist Sonia Shah sets out to answer these questions, delivering a timely, inquisitive chronicle of the illness and its influence on human lives. Through the centuries, she finds, we’ve invested our hopes in a panoply of drugs and technologies, and invariably those hopes have been dashed. From the settling of the New World to the construction of the Panama Canal, through wars and the advances of the Industrial Revolution, Shah tracks malaria’s jagged ascent and the tragedies in its wake, revealing a parasite every bit as persistent as the insects that carry it. With distinguished prose and original reporting from Panama, Malawi, Cameroon, India, and elsewhere, The Fever captures the curiously fascinating, devastating history of this long-standing thorn in the side of humanity.
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Sonia Shah is a science journalist and author of the prize-winning The Body Hunters: Testing New Drugs on the World's Poorest Patients, named one of the best consumer health books of 2006 by Library Journal, and Crude: the Story of Oil. A former writing fellow of The Nation Institute and the Puffin Foundation, her writing has appeared in The Lancet, The Nation, New Scientist and elsewhere.Excerpt. © Reprinted by permission. All rights reserved.:
The view through the mosquito net is blurry, but I can see the
thick skin of grime on the leading edge of each blade of the
ceiling fan as it slowly whirs around, keening alarmingly.
This is how it was every summer when I visited my grandmother’s
house in southern India. While my cousins snore on the bed mats
laid across the floor beside me, glistening bodies bathed in the warm
night breeze, my sleeping mat is ensconced in a hot, gauzy cage. The
mosquitoes descend from the darkened corners of the whitewashed
room and perch menacingly on the taut netting, ready to exploit any
fl icker of movement from their prey within. It is hard to fall asleep
knowing they are there, watching me, but eventually I drop off and
my tensed body uncurls. They sneak into the gaps my protruding
limbs create, and feast.
In the morning, all my hard work of trying to fi t in, to overcome
the Americanness of my suburban New England life, has been
undone, for my Indian cousins are smooth and brown while I am
speckled with bleeding scabs. My grandmother vigorously pats talcum
powder over my wounds, the white powder caking pink with
congealed blood, as my cousins snicker. I don’t understand how they
escape unscathed while I am tormented. But incomprehension is part
of the package of these childhood summers in India. Just outside my
grandmother’s house ragged families huddle in rubble along the road
and use the train tracks as their toilet. They wave their sticklike arms
in my face and moan woefully when we pass by on the way to temple,
caricatures of beggars. One boy’s leg has swollen to the size of a log,
and is gray and pimpled, from some disease brought on by a mosquito
bite. My grandmother tightens her grip on my hand. We give
the children nothing. I can’t understand this, either. When we get to
the white marble temple, it is full of incense and golden statues
encrusted with diamonds and rubies—to my seven-year-old mind,
the very picture of prosperity.
Part of me despises my estrangement, my incomprehension, the
fact that I must sleep under the suffocating net and take the malaria
pills while my cousins don’t. But part of me is secretly glad. The boy
with the swollen leg frightens me. The family who lives on the curb
frightens me. India frightens me. These fears, for the girl who is supposed
to be Indian but isn’t, are unspeakable.
When no one is looking, I crush the mosquitoes’ poised little
figures with my palm and smear the remains on a hidden seam in
the couch. Our Jain religion forbids violence of any kind. No eating
meat. No swatting flies. My grandmother wears a mask over her
mouth while she prays, to protect airborne microbes from inadvertent
annihilation in her inhalations, and considers walking on
blades of grass a sin. Meanwhile, there I am in the corner, cravenly
pulverizing mosquito corpses behind my back, blood literally on
Back home in New England, the mosquitoes still bite, but there
are no nets at night, no pills to take, no scary beggars on the side of
the road. We shop for forgettable plastic trinkets at the mall. My fear
and loathing of the mosquito are blunted into games of tag. My father
calls himself Giant Mosquito, undulates his fingers like proboscises
and chases me and my sister. It’s scary, but fun-scary. We screech
with glee and stampede through the house.
· · ·
Thirty years later, on the S-shaped land bridge between the North
and South American continents, I meet José Calzada. Calzada is a
mosquito stalker of sorts, and I, the mosquito hater, have come to
learn about the local mosquitoes and their exploits. A parasitologist
from Panama City, Panama, Calzada spends his time rushing to the
scene of disease outbreaks across the isthmus. The mosquito-borne
parasite that causes malaria, Plasmodium, is one of his specialties.
It is April 2006. For most of the past century, there hasn’t been
much work in this fi eld for people such as Calzada. Panama prides
itself on being one of just a handful of tropical developing countries
to have tamed its mosquitoes and nearly conquered malaria. American
military engineers built a canal through Panama in the early
1900s, and forced malaria to retreat to the remote fringes of the
country. Since then it has stagnated, primarily in its most benign
incarnation, vivax malaria, which is rarely fatal.
But things have changed in recent years, and Calzada has agreed
to show me some obscure signs. He emerges from the imposing
Gorgas Memorial Institute, Panama’s sole health research center.
Clean-shaven and trim, Calzada has a slightly worried look in his
eyes that is off set by high cheekbones suggesting a perpetual halfsmile.
I wait while he meticulously changes out of his work clothes—
button-down oxford shirt and slacks—and into a T-shirt and jeans.
Climbing into my diminutive white rental car and tossing a baseball
cap on top of his backpack in the backseat, he patiently directs me
out of the labyrinthine metropolis. Navigating Panama City’s congested
streets, past shiny skyscrapers and packed cafés, is a task that
challenges even my well-honed Boston driv ing skills.
After twenty minutes heading east out of the city, the road turns
quiet. It’s a lovely drive, with hills in the distance, verdant pasture
and scrub unbroken save for a few elaborately gated houses set far
back from the road. Colombian drug lords, Calzada says, by way of
explanation. Another hour passes, and the road rises, a glittering
lake coming into view, just visible through a tangle of jungle. As we
near the water, the pavement ends, and we pull over.
Here, at the end of the road, is the town of Chepo. From what I
can see, it consists of a wooden lean-to facing a sleepy roadside café.
Two police officers amble out of the lean-to, which turns out to be a
checkpoint. They take my passport and vanish, leaving Calzada and
me to buy a cold drink at the near-empty café. As we sit, I can just
make them out in the murk within the lean-to, inspecting the blue
passport with great care, turning it over and over in their hands as if
for clues to some baffling mystery.
Inspection completed, Calzada leads us on foot behind the road.
Th e hillside is green and lush, with a slick red clay track leading to
the crest. He heads up and I follow gingerly.
At the top of the hill lies an improb able settlement. Packed
together, not ten feet apart, are dozens of hand-built ranchos, their
thatched roofs sitting on top of roughly hewn wooden poles. More
arbor than hut, some of the structures rest on concrete slabs, with
airy wooden-slat walls on three sides, but most are fully open-air,
situated directly on the packed dirt. Inside the ranchos, smoldering
fi res are encircled by battered metal cooking vats, parrots sit on overturned
baskets, and hammocks sway from high rafters.
From the road, Chepo seems abandoned, but in fact, three hundred
of Panama’s indigenous Kuna people live here, tucked away.
It starts to rain, and we duck under the eaves of a rancho. Women
pass to and fro in bright puff ed-sleeve cotton blouses with patterned
molas tied around their waists and elaborate beaded anklets that
reach up to their calves. They are cutting plantains, carrying plump
naked children. One puts out a giant metal vat to collect the rainwater
sliding off the thatch. A rooster strides by purposefully.
A half-dozen boys clad in saggy cotton underwear and wearing
shell necklaces happily kick a defl ated green soccer ball. One boy,
around eight years old and wearing cracked red plastic flip-flops,
gnaws on a green mango pit while absentmindedly pulling on his
penis. A little girl walks by holding a baby covered in a rash, whom
she hands to me easily. It is a tranquil scene, earthy and ripe, this
hidden place at the end of the road.
It is soon apparent that most of the residents are in one of the
larger ranchos, sitting around a smoky fire. Peeking in, we see them
singing softly and dancing. A few are sprawled on the clay floor,
facedown, passed out. We’ve arrived in the midst of a fiesta, Calzada
whispers to me. A local girl has recently menstruated for the fi rst
time, and so the community has spent the day drinking chicha fuerte,
a brew made from fermented corn. As we watch, a woman and a
boy lift a comatose mud-caked man off the ground and drag him
home. Two women from inside the rancho follow them to the doorway,
smiling. Aside from a few furtive looks, they ignore us almost
It wasn’t like this the year before, when Calzada first came here.
There is no En glish-language record of what happened to Chepo’s
Kuna community in 2005, save the one you are reading now. The
mosquitoes that hatched from Chepo’s stagnant puddles, the edges
of the lake below, in the open-water cisterns, had gone on a rampage.
Contaminated with the most malevolent malaria parasites known to
humankind in their spittle, they alit on the exposed and unclad Kuna
around them. By the time Calzada and his team arrived, nearly half
of the settlement was fevered, terrified, immobilized in their hammocks.
After days of triage, Calzada brought samples of the Kuna’s infected
blood back to his lab at the Gorgas Institute to analyze. The
most common malaria in this part of Panama is the relativ...
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